Going beyond the individual: developing the evidence base for whole population-based dementia prevention strategies, to inform local government policies

Award Number
Award Type
Doctoral Fellowship
NIHR Fellowships
Status / Stage
5 February 2022 -
5 January 2025
Duration (calculated)
02 years 11 months
Funding Amount
Funder/Grant study page
Contracted Centre
University of Cambridge
Principal Investigator
Dr Sebastian Walsh
PI Contact
WHO Catergories
Methodologies and approaches for risk reduction research
Disease Type
Dementia (Unspecified)

CPEC Review Info
Reference ID8
ResearcherReside Team


Award NumberNIHR302276
Status / StageActive
Start Date20220205
End Date20250105
Duration (calculated) 02 years 11 months
Funder/Grant study pageNIHR
Contracted CentreUniversity of Cambridge
Funding Amount£367,000.00


Dementia prevalence in the UK is forecasted to double to 1.6 million by 2040. Available treatments are minimally effective, but up to 40% of dementia is thought to be preventable. Optimisation of prevention strategies is vital. Current approaches tend towards ‘high-risk approaches’ that identify and encourage individuals at highest-risk of disease to change their lifestyle (e.g. NHS Health Checks). Rose’s Prevention Paradox predicts that most cases of disease actually occur within the large proportion of the population at ‘normal’ or ‘slightly-elevated’ risk. We should therefore adopt more ‘whole population-based approaches’ (e.g. providing more, high-quality green spaces) to reduce risk across the spectrum rather than only target ‘high-risk’ individuals. Aims:Develop the evidence-base for whole population-based approaches to dementia prevention, to inform local government policy change.Research Projects What is known about whole population-based interventions to prevent dementia? A meta-review of existing systematic reviews. Apply a sampling frame of existing systematic reviews of dementia prevention interventions, and whole population-based prevention interventions more generally. Systematically summarise what is currently known about whole population-based interventions to prevent dementia. Retrospective cohort study to determine what proportion of incident cases of dementia would have been considered ‘high-risk’ in midlife. EPIC Norfolk is a population-representative cohort established in the 1990s (baseline n=30,000), with linked NHS data up to 2019. A retrospective cohort study using incident cases of dementia (n=3,187) and analysing what their baseline Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score (dementia risk prediction score) would have been, will directly test the applicability of the Prevention Paradox to dementia. Apply the risk score to the current Health Survey for England dataset, to assess comparability of today’s population risk with the EPIC-Norfolk baseline cohort. Policy mapping analysis of dementia prevention policies, using Stevenage, Hertfordshire as a case study. Identify and characterise existing international, national, regional, and local dementia prevention policies applied to the population of Stevenage, according to the type of prevention approach. Include explicit dementia prevention policies at all levels, and additionally include policies targeted at modifiable risk factors for dementia at the regional and local levels. Understanding policymakers’ views and attitudes towards dementia prevention approaches, and what is required to shift policy towards whole population-based approaches. Present the findings of these projects to the key local policymakers and commissioners and then hold focus groups to explore their views and attitudes towards dementia prevention approaches, and how they have changed with the findings of projects 1-3. DisseminationI will summarise the findings of all projects into an evidence toolkit that will be shared with local government public health teams across the country. This toolkit will detail the evidence-base for, and policymakers’ views of, whole population-based approaches to dementia prevention.Timelines for DeliveryI will start by ensuring data access and ethics are in place. I will then commence project 1,2 and 3, in that order, over the first 2 years of the proposal. The final year of the PhD will be focussed on delivering project 4 and producing the evidence toolkit.


Develop the evidence-base for whole population-based approaches to dementia prevention, to inform local government policy change.